KARIN ÖN DUVARI FITIKLARININ TAMİRİNDE AÇIK VE LAPAROSKOPİK YÖNTEMLERİN SONUÇLARININ KARŞILAŞTIRILMASI

Yıl 2017, Cilt: 80 Sayı: 2, 54 - 58, 30.06.2017

İsmail Cem Sormaz , Bahar Canbay Adem Bayraktar , İbrahim Fethi Azamat Şeyma Karakuş Elnur Hüseynov Levent Avtan

https://doi.org/10.18017/iuitfd.329884

Öz

Amaç: Bu çalışmada, kliniğimizde son dört sene içerisinde karın ön duvarı
fıtığı nedeniyle laparoskopik ve açık yöntemlerle ameliyat edilen hastaların
sonuçları karşılaştırıldı.

Gereç ve Yöntem: Ocak 2012 ve Ocak 2016 tarihleri arasında kliniğimizde
karın ön duvarı fıtığı nedeniyle ameliyat edilen ve verileri kayıt edilen 76
olgunun verileri retrospektif olarak incelendi. Karın ön duvarı fıtıkları (kesi
yeri fıtığı ve ventral herniler) dışında inguinal, femoral veya Spiegel gibi
diğer karın duvarı fıtıkları nedeniyle ameliyat edilen hastalar çalışmaya
alınmadı. Yama kullanılmadan primer tamir uygulanarak ameliyat edilen tüm karın
duvarı fıtıkları da çalışmaya alınmadı. Çalışmaya dahil edilen 76 hasta,
ameliyatı laparoskopik olarak bitirilen 43 hasta, grup 1 (n:43, %56,5 ), onlay
teknik ile yama yerleştirilen hastalar ise grup 2 (n:33, %43,5) olarak tanımlandı.
Olgular, demografik veriler, vücut kitle indeksi (VKİ), onarım yöntemleri,
ameliyat süreleri, hastanede kalış süreleri ve ameliyat sonrası komplikasyonlar
açısından değerlendirildi.

Bulgular: Ameliyata laparoskopik olarak başlanılan 44 hastadan
43’ünün ameliyatı laparoskopik olarak, 33 hastanın ameliyatı ise açık cerrahi
teknik ile bitirildi. İki grubun demografik verileri arasında anlamlı bir fark
saptanmadı. Laparoskopik grupta ameliyat süresi açık gruba oranla anlamlı
olarak daha yüksek bulundu. Buna karşılık hastanede kalış süresi anlamlı olarak
daha düşük bulundu. Ameliyat esnasında ve sonrasında gelişen genel komplikasyon
oranları karşılaştırıldığında Grup 2’de anlamlı şekilde daha fazla komplikasyon
geliştiği saptandı. Nüksü etkileyen faktörler karşılaştırıldığında ise
laparoskopik ve açık teknik arasında fark olmadığı, ancak geçirilmiş fıtık
cerrahisinin nüks için önemli bir risk faktörü olduğu saptandı.

Sonuç: Çok
büyük ventral herniler (≥15cm) dışında laparoskopinin güvenli bir şekilde, yüksek hasta memnuniyeti ile
birlikte güvenli bir şekilde uygulanabileceği kanaatindeyiz.

Anahtar
kelimeler: Karın ön
duvarı fıtığı; ventral herni; insizyonel herni; kesi fıtığı; herniorafi;
laparoskopik tamir.

Anahtar Kelimeler

Karın ön duvarı fıtığı, ventral herni, insizyonel herni, kesi fıtığı, herniorafi, laparoskopik tamir

COMPARISON OF RESULTS OF LAPAROSCOPIC AND OPEN REPAIR TECHNIQUES IN VENTRAL AND INCISIONAL HERNIAS

Öz

Objective: In this study, we compared the results
of patients who underwent laparoscopic and open ventral and incisional hernia
repair in our clinic during last four years.

Materials and Methods: The data of 76 patients who underwent
surgery for ventral and incisional hernia
between January 2012 and
January 2016 in our clinic were analyzed
retrospectively. The patients who underwent surgery for other types of
abdominal wall hernias (such as inguinal, femoral, Spiegelian etc.) and patients who underwent primary repair without use of mesh were excluded. Forty-three patients
(n: 43, 56,5%) whose operation was
completed laparoscopically were defined as group1 and 33 patients (n:33,
%43,5) who were operated using mesh with onlay
technique were defined as group2. The
cases were evaluated in terms of demographic data, body mass index (BMI),
repair procedures, operation time, duration of hospital stay and postoperative
complications.

Results: In
44 patients, operation was initiated laparoscopically and in 43 were completed
laparoscopically, whereas 33 patients were operated by open surgical technique. There was no
significant difference in demographic data between these two groups. In the laparoscopic group, the operation time
was significantly higher than the open group. However, the duration of hospital
stay was significantly shorter. When the general complication rates during and
after the surgery were compared, it was found that group 2 had significantly
more complications. When the factors affecting recurrence were compared, it was
found that there was no difference between laparoscopic and open techniques,
but the history of a previous hernia operation was an important risk factor for
recurrence.

Conclusion: In our opinion laparoscopy can be
safely performed with high patient satisfaction except in cases with very large
ventral hernias (≥15 cm).

Keywords: Abdominal wall hernia; ventral hernia; incisional hernia;
hernioraphy; laparoscopic repair.

Anahtar Kelimeler

Abdominal wall hernia, ventral hernia, incisional hernia, hernioraphy, laparoscopic repair

Kaynakça

• 1. Bedewi MA, El-Sharkawy MS, Al Boukai AA, Al-Nakshabandi N. Prevalence of adult paraumbilical hernia. Assessment byhigh-resolution sonography: a hospital-based study. Hernia. 2012;16(1):59–62.
• 2. Martindale RG, Deveney CW. Preoperative risk reduction: strategies to optimize outcomes. Surg Clin NorthAm 2013;93(5):1041–55.
• 3. George CD, Ellis H. The results of incisional hernia repair: a twelve-year review. Ann R Coll Surg Engl. 1986;68:185–7.
• 4. Usher FC, Ochsner J, Tuttle LLD. Use of Marlex mesh in repair of incisional hernias. Am Surg 1958; 24:969–74.
• 5. Anthony T, Bergen PC, Kim LT, Henderson M, Fahey T, Rege RV, et al. Factors affecting recurrence following incisional herniorrhaphy. World J Surg 2000; 24(1):95–100.
• 6. Luijendijk RW, Hop WC, van den Tol MP, de Lange DC, Braaksma MM, Ijzermans JN, et al. A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 2000; 343(6):392-8.
• 7. Morris-StiV GJ, Hughes LE. The outcomes of nonabsorbable mesh placed within the abdominal cavity: literature review and clinical experience. J Am Coll Surg 1998; 186(3):352–67.
• 8. Holzman MD, Purut CM, Reintgen K, Eubanks S, Pappas TN. Laparoscopic ventral and incisional hernioplasty. Surg Endosc 1997; 11(1):32–5.
• 9. Leber GE, Garb JL, Alexander AI, Reed WP. Longterm complications associated with prosthetic repair of incisional hernias. Arch Surg 1998; 133(4):378–382.
• 10. LeBlanc KA, Booth WV. Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings. Surg Laparosc Endosc 1993;3:39–41.
• 11. White TJ, Santos MC, Thompson JS. Factors aVecting wound complications in repair of ventral hernias. Am Surg 1998; 64(3):276–80.
• 12. Carbajo MA, Martp del Olmo JC, Blanco JI, Toledano M, de la CC, Ferreras C, et al. Laparoscopic approach to incisional hernia. Surg Endosc 2003; 17(1):118–22.
• 13. Carbajo MA, del Olmo JC, Blanco JI, de la CC, Martin F, Toledano M, et al. Laparoscopic treatment of ventral abdominal wall hernias: preliminary results in 100 patients. JSLS 2000; 4(2):141–5.
• 14. Heniford BT, Park A, Ramshaw BJ, Voeller G. Laparoscopic ventral and incisional hernia repair in 407 patients. J Am Coll Surg. 2000; 190(6):645–50.
• 15. Berger D, Bientzle M, Muller A. Postoperative complications after laparoscopic incisional hernia repair. Incidence and treatment. Surg Endosc 2002; 16(12):1720–3.
• 16. Barbaros U, Asoglu O, Seven R, Erbil Y, Dinccag A, Deveci U, et al. The comparison of laparoscopic and open ventral hernia repairs: a prospective randomized study. Hernia 2007; 11(1), 51-6.
• 17. Othman H,Methwally YH, Bakr IS, Amer YA, GaberMB, Egohary SA. Comparative study between laparoscopic and open repair of paraumbilical hernia. J Egypt Soc Parasitol 2012; 42: 175-82.
• 18. Hussain D, Sarfraz SL, Kasmani JS, Baliga KS, Ibrahim M, Syed HS, et al. Laparoscopic Repair of Ventral Hernia. J Coll Physicians Surg Pak 2012; 22: 683-5.
• 19. Heniford BT, Park A, Ramshaw BJ. Laparoscopic repair of ventral hernias. A nine year experience with 850 consecutive hernias. Ann Surg. 2003; 238: 391-400.
• 20. Malik AM. Laparoscopic versus open repair of para-umbilical hernia. Is it a good alternative? J Pak Med Assoc 2015;65(8):865-8.
• 21. Itani KM, Hur K, Kim LT, Anthony T, Berger DH, Reda D, Neumayer L; Veterans Affairs Ventral Incisional Hernia Investigators. Comparison of laparoscopic and open repair with mesh for the treatment of ventral incisional hernia: arandomized trial. Arch Surg 2010;145:322-8.
• 22. Castro PMV, Rabelato JT, Monteiro GGR, GUERRA GCD, Mazzurana M, et al. Laparoscopy versus laparotomy in the repair of ventral hernias: systematic review and meta-analysis. Arquivos de gastroenterologia 2014; 51(3), 205-211.
• 23. Itani KM, Neumayer L, Reda D, Kim L, Anthony T. Repair of ventral incisional hernia: the design of a randomized trial to compare open and laparoscopic surgical techniques. Am J Surg 2004; 188(6S):22–9 24. Pring CM, Tran V, O’Rourke N, Martin IJ. Laparoscopic versus open ventral hernia repair: a randomized controlled trial. ANZ J Surg 2008;78:903-6.
• 25. Carbajo MA, Martín del Olmo JC, Blanco JI, de la Cuesta C, Toledano M, et al. Laparoscopic treatment vs open surgery in the solution of major incisional and abdominal wall hernias with mesh. Surg Endosc 1999;13:250-2.